Provider Demographics
NPI:1063203313
Name:GONSMAN, JENNIFER ROBIN
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROBIN
Last Name:GONSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 ELDER PARK RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-9303
Mailing Address - Country:US
Mailing Address - Phone:502-718-6871
Mailing Address - Fax:502-718-6871
Practice Address - Street 1:2409 ELDER PARK RD
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9303
Practice Address - Country:US
Practice Address - Phone:502-718-6871
Practice Address - Fax:502-718-6871
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1137313363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily